POS1369 CHANGES IN PAIN AND REACHING THE PATIENT ACCEPTABLE SYMPTOM STATE IN HAND OSTEOARTHRITIS OVER 4 YEARS
Authors: C. Van der Meulen, L. Van de Stadt, S. Buck, F. Rosendaal, M. Kloppenburg
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Hand pain is common in hand osteoarthritis (OA). <h3>Objectives</h3> This study aimed to characterize patients with an increase or decrease in pain, and to investigate which patients are likely to achieve a good clinical outcome after four years. <h3>Methods</h3> Four year data from the ongoing HOSTAS (Hand OSTeoArthritis in Secondary care) cohort were used, consisting of 538 consecutive patients with primary hand OA diagnosed by their rheumatologist. Hand pain was measured with the pain subscale of the Australian/Canadian hand osteoarthritis index (AUSCAN, range 0-20) annually. Demographics, disease characteristics and patient characteristics were collected, as were the Short Form (SF)-36 and Hospital Anxiety and Depression Scale (HADS). Change in pain was categorized as increase, stable or decrease according to the AUSCAN pain minimal clinical important difference (MCID, 1.6) between baseline and year 4. Good clinical outcome was defined as an AUSCAN pain score below the Patient Acceptable Symptom State (PASS) of 8.2 (Bellamy 2015). All patients with measurements at baseline and year 4 (MCID analysis) and at year 4 (PASS analysis) were included. Associations between determinants and change in pain or PASS were investigated using multinomial or binary logistic regression, respectively. <h3>Results</h3> Of 356 patients included in the MCID analysis, 83% were female, mean age was 60.6 years and mean AUSCAN pain score was 9.1. Over 4 years, pain decreased in 137, increased in 106, and 113 remained stable. In the decrease group, mean (SD) change in pain was -4.8 (2.8), in the stable group -0.1 (0.8), and in the increase 3.8 (1.9). Baseline BMI was positively associated with increase in pain. Health-related quality of life (HR-QoL) at baseline was positively associated with decrease in pain. Employment was positively associated with both increase and decrease in pain. HADS scores were negatively associated with decrease in pain (Table 1). Of 361 in the PASS analysis, 155 were below the PASS at baseline, and 177 were below the PASS after 4 years. Patient characteristics and disease characteristics at baseline were not associated with PASS after 4 years. Higher physical HR-QoL and lower pain level at baseline were associated with a higher chance of reaching PASS (data not shown). <h3>Conclusion</h3> Change in pain is associated with BMI, HR-QoL, mental wellbeing and employment status. Good clinical outcome is associated with physical health-related quality of life. These factors can help identify patients likely to achieve good clinical outcome and may aid stratified patient selection for trials. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Coen van der Meulen Grant/research support from: The HOSTAS study is supported by a grant from the Dutch Arthritis Society, paid to the institution, Lotte van de Stadt: None declared, Saskia Buck: None declared, Frits Rosendaal: None declared, Margreet Kloppenburg Grant/research support from: The HOSTAS study is supported by a grant from the Dutch Arthritis Society, paid to the institution.